Physiological Changes in Pregnancy

Question 1

Which hormones does the anterior pituitary increase during pregnancy

Answer 1

ACTH, prolactin and melanocyte stimulating hormone

Question 2

What is the effect of increased levels of ACTH in pregnancy

Answer 2

Causes a rise in steroid hormones such as cortisol and aldosterone

Question 3

What is the effect of increased levels of prolactin in pregnancy

Answer 3

It suppresses LH and FSH

Question 4

What are the effects of increased levels of melanocyte stimulating hormone in pregnancy

Answer 4

Increased pigmentation in skin leading to linea nigra and melasma

Question 5

What happens to thyroid hormones during pregnancy

Answer 5

TSH remains normal
T3 and T4 rise

Question 6

What happens to hCG levels during pregnancy

Answer 6

Roughly double every 48 hours until 8-12 weeks, then plateau, and then gradually start to fall

Question 7

Why do levels of progestone rise throughout pregnancy

Answer 7

Acts to maintain pregnancy, prevent contractions and suppress mothers immune reaction to fetal antigens.

Question 8

What causes the levels of oestrogen to rise during pregnancy

Answer 8

Placenta

Question 9

What causes the levels of progesterone to rise during pregnancy

Answer 9

Corpus luteum and then the placenta

Question 10

What changes occur to the uterus, cervix and vagina during pregnancy

Answer 10

Hypertrophy of myometrium and blood vessels, hypertrophy of vaginal muscles and increased vaginal discharge

Question 11

Cardiovascular changes in pregnancy

Answer 11

Increased blood volume, plasma volume, cardiac output.
Decreased peripheral resistance and blood pressure.
Varicose veins due to vasodilation and obstruction of IVC by uterus, which also causes flushing and hot sweats

Question 12

Respiratory changes in pregnancy

Answer 12

Tidal volume and respiratory rate increase in later pregnancy to meet increased oxygen demands

Question 13

Renal changes in pregnancy

Answer 13

Increased blood flow to kidney, GFR, aldosterone (salt and water retention), protein excretion.
Dilatation of ureters and collecting system leading to physiological hydronephrosis

Question 14

Haematological changes in pregnancy

Answer 14

Anaemia
Hyper-coagulable state
Increased and decreased molecules on blood results.

Question 15

Which haematological agents increase during pregnancy

Answer 15

WBCs, RBCs, plasma volume, clotting factors, ESR, D-dimer, ALP

Question 16

Which haematological agents decrease during pregnancy

Answer 16

Platelet count, albumin (loss of protein in kidneys)

Question 17

Why do calcium levels remain stable in pregnancy

Answer 17

Calcium requirements increase but so does the gut absorption

Question 18

Why do calcium levels remain stable in pregnancy

Answer 18

Calcium requirements increase but so does the gut absorption

Question 19

Why does anaemia occur in pregnancy

Answer 19

There is an increase in RBC production but also plasma more so, which reduces the concentration. Requirement of more iron, folate and B12 from increased RBC production.

Question 20

Why do mothers enter a hypercoagulable state in pregnancy

Answer 20

Fibrinogen, factor VII, VIII and X increase during pregnancy -> increased risk of VTE

Question 21

Skin and hair changes which occur in pregnancy

Answer 21

Increased skin pigmentation, striae gravidarum, pruritis, spider naevi, palmar erythema, hair loss post partum

Question 22

GI changes in pregnancy

Answer 22

Early pregnancy vomiting mediated by hCG. Increased gastric emptying and gastro-oesophageal sphincter tone leading to acid reflux. Decreased colonic motility (constipation). Biliary stasis due to progesterone. Haemorrhoids

Question 23

Metabolic changes in pregnancy

Answer 23

Increased protein metabolism and deposition so increase in weight. Increased carbohydrate metabolism and insulin resistance.

Question 24

MSK changes in pregnancy

Answer 24

Relaxation of sacroiliac joints and symphysis pubis, facilitating vaginal delivery but may lead to discomfort. Soft tissue remodelling and joint changes. MSK pain. Lordosis.